The information is easily accessible on the Internet, and can be printed out for the patients. This includes having a regular sleep-wake time even during the weekends, avoiding long naps and avoiding coffee, tea and drinks with stimulants. Hence, the interventions should also have a multi-pronged approach, and should be persisted.Įducating patients on good sleep hygiene is straightforward and essential. It takes patience to explain that the causes are multifactorial. Some patients may have already tried some of these methods with limited success. However, they do not have the risk of a dependence, or the other side effects, of medications.
All these techniques take time to learn, more effort to execute and may not offer same-day results. It consists of various techniques, that may target either the behavioural or cognitive aspects of insomnia.īehavioural techniques include advice on sleep hygiene, relaxation techniques and stimulus control.Ĭognitive techniques focus on challenging the negative and distorted thoughts, and replacing it with helpful ones. How it impacts relationships, leisure, school and work activitiesĬognitive-behavioural therapy, in the management of insomnia, is a first-line treatment, and it might be better than pharmacological treatment in the long-termĤ.(for e.g., theophylline and beta-blockers) (for e.g., urinary frequency and chronic pain) Jerks observed by the partner of the patient Restlessness, discomfort in the limbs precipitated by rest The partner of the patient observed signs of Pleasurable activities, a lack of meaning in lifeĮxcessive worries over the circumstances of life,Ī history of frequent alcohol use or illicit drug use Low mood, appetite changes, withdrawal from Drinks with stimulants (coffee, tea and cola).The times at which the patient goes to bed, falls asleep and wakes up, as well as any intermittent awakenings that occur.Table 1 Important Sleep History to Elicit This is to exclude the diagnosis of other sleep disorders (such as OSA, a periodic limb movement disorder and narcolepsy), and are not used to diagnose insomnia. In a Sleep Centre, investigations such as polysomnography (a type of sleep study), and multiple sleep latency tests, are ordered. Sleep logs or sleep diaries can give a clearer account, and may also be helpful for the monitoring of progress.
Some of these could be “I will not be able to perform well at work tomorrow”, “I will drive poorly” and “my friends will notice that I look tired.” These thoughts and feelings, make the reaching of the state of relaxation that is required for sleep, harder.Ī mental state examination, a physical examination and appropriate investigations as guided by the history, should follow. Patients often report experiencing anxiety, associated with automatic negative thoughts, as the night falls. If possible, a corroborative history from the partner, and the family members of the patient, should be obtained. It will be helpful to find out what methods have been tried, as well as to ask for the expectations of the patient. The next step, will be to screen for the psychiatric conditions, such as depression and anxiety disorders, as well as other sleep disorders, such as the Restless Legs Syndrome (RLS) and Obstructive Sleep Apnoea (OSA). It is important to ask for more details of the sleep patterns and the daily routine (Refer to Table 1), so as to elicit the contributing factors of the insomnia. In Singapore, there are also stringent regulations of hypnotic agents, such as benzodiazepines. This is partly due to the lengthy consultation that is required to ascertain the contributing factors, and the advice is lengthy as well. It can be challenging to manage insomnia in primary care. Therefore, the current diagnostic criteria is simple, yet more practical However, the patients tend to have multiple contributing causes, as well as symptoms that span across various subtypes. In the past, there used to be various subtypes of insomnia, and there were also attempts to differentiate between the primary and secondary causes of insomnia. These episodes of insomnia should occur at least 3 times per week, for at least Some of the salient features, are a difficulty in initiating sleep, in maintaining sleep or an early morning awakening, resulting in socio-occupational impairments.
#SLEEPLESS NEAR ME MANUAL#
The diagnostic criteria of chronic insomnia, from the ICSD-3 (International Classification of Sleep Disorders, 3rd Edition) and the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) share many similarities, due to the close collaborations between the work groups. A recent local study also found that 13.7% of older adults aged 60 and above, were reported to experience insomnia 2. INSOMNIA is a common sleep disorder in Singapore, with a local reported rate of 15.3% 1.
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